TY - JOUR
T1 - Risk Factors for Prognosis in Patients With Severely Decreased GFR
AU - CKD Prognosis Consortium
AU - Evans, Marie
AU - Grams, Morgan E.
AU - Sang, Yingying
AU - Astor, Brad C.
AU - Blankestijn, Peter J.
AU - Brunskill, Nigel J.
AU - Collins, John F.
AU - Kalra, Philip A.
AU - Kovesdy, Csaba P.
AU - Levin, Adeera
AU - Mark, Patrick B.
AU - Moranne, Olivier
AU - Rao, Panduranga
AU - Rios, Pablo G.
AU - Schneider, Markus P.
AU - Shalev, Varda
AU - Zhang, Haitao
AU - Chang, Alex R.
AU - Gansevoort, Ron T.
AU - Matsushita, Kunihiro
AU - Zhang, Luxia
AU - Eckardt, Kai Uwe
AU - Hemmelgarn, Brenda
AU - Wheeler, David C.
N1 - Funding Information:
NJB received grant support from Baxter Healthcare. ME received grant support from the Stockholm County Council (award number 20130605 from 2014–2017). PBM received consulting fees from Astellas and Novartis, lecture fees from Eli-Lilly and Janssen, and grant support from Boehringer Ingelheim. KM received consulting fees from Kyowa Hakko Kirin, lecture fees from Kyowa Hakko Kirin and Daiichi Sankyo, travel support from Kyowa Hakko Kirin, and grant support from Kyowa Hakko Kirin. OM received lecture fees from Baxter Fresenius Roche, travel support from Sanofi Roche, and grant support from SFNDT Agence de Biomedecine Roche Fresenius Baxter Roche. PRao received grant support from NIDDK (U01-DK-061028-16-S1). VS received grant support from the Israeli Ministry of the Environment. DCW received lecture fees from Amgen, Janssen, and Vifor Fresenius Medical Care Renal Pharma; travel support from Amgen; and grant support from Kidney Research UK and Healthcare Quality Improvement Partnership. All the other authors declared no competing interests.
Funding Information:
This project was funded by the Kidney Disease: Improving Global Outcomes Foundation. The Chronic Kidney Disease Prognosis Consortium Data Coordinating Center is funded in part by a program grant from the US National Kidney Foundation, the Kidney Disease: Improving Global Outcomes Foundation, and the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100446-01). A variety of sources have supported enrollment and data collection, including laboratory measurements, and follow-up in the collaborating cohorts of the Chronic Kidney Disease Prognosis Consortium. These funding sources include government agencies, such as national institutes of health and medical research councils, as well as foundations and industry sponsors listed in Supplementary Appendix S3 . The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Some of the data reported here have been supplied by the US Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US government.
Publisher Copyright:
© 2018 International Society of Nephrology
PY - 2018/5
Y1 - 2018/5
N2 - Introduction: Patients with chronic kidney disease (CKD) and estimated glomerular filtration rate (eGFR) <30 ml/min per 1.73 m2 (corresponding to CKD stage G4+) comprise a minority of the overall CKD population but have the highest risk for adverse outcomes. Many CKD G4+ patients are older with multiple comorbidities, which may distort associations between risk factors and clinical outcomes. Methods: We undertook a meta-analysis of risk factors for kidney failure treated with kidney replacement therapy (KRT), cardiovascular disease (CVD) events, and death in participants with CKD G4+ from 28 cohorts (n = 185,024) across the world who were part of the CKD Prognosis Consortium. Results: In the fully adjusted meta-analysis, risk factors associated with KRT were time-varying CVD, male sex, black race, diabetes, lower eGFR, and higher albuminuria and systolic blood pressure. Age was associated with a lower risk of KRT (adjusted hazard ratio: 0.74; 95% confidence interval: 0.69–0.80) overall, and also in the subgroup of individuals younger than 65 years. The risk factors for CVD events included male sex, history of CVD, diabetes, lower eGFR, higher albuminuria, and the onset of KRT. Systolic blood pressure showed a U-shaped association with CVD events. Risk factors for mortality were similar to those for CVD events but also included smoking. Most risk factors had qualitatively consistent associations across cohorts. Conclusion: Traditional CVD risk factors are of prognostic value in individuals with an eGFR <30 ml/min per 1.73 m2, although the risk estimates vary for kidney and CVD outcomes. These results should encourage interventional studies on correcting risk factors in this high-risk population.
AB - Introduction: Patients with chronic kidney disease (CKD) and estimated glomerular filtration rate (eGFR) <30 ml/min per 1.73 m2 (corresponding to CKD stage G4+) comprise a minority of the overall CKD population but have the highest risk for adverse outcomes. Many CKD G4+ patients are older with multiple comorbidities, which may distort associations between risk factors and clinical outcomes. Methods: We undertook a meta-analysis of risk factors for kidney failure treated with kidney replacement therapy (KRT), cardiovascular disease (CVD) events, and death in participants with CKD G4+ from 28 cohorts (n = 185,024) across the world who were part of the CKD Prognosis Consortium. Results: In the fully adjusted meta-analysis, risk factors associated with KRT were time-varying CVD, male sex, black race, diabetes, lower eGFR, and higher albuminuria and systolic blood pressure. Age was associated with a lower risk of KRT (adjusted hazard ratio: 0.74; 95% confidence interval: 0.69–0.80) overall, and also in the subgroup of individuals younger than 65 years. The risk factors for CVD events included male sex, history of CVD, diabetes, lower eGFR, higher albuminuria, and the onset of KRT. Systolic blood pressure showed a U-shaped association with CVD events. Risk factors for mortality were similar to those for CVD events but also included smoking. Most risk factors had qualitatively consistent associations across cohorts. Conclusion: Traditional CVD risk factors are of prognostic value in individuals with an eGFR <30 ml/min per 1.73 m2, although the risk estimates vary for kidney and CVD outcomes. These results should encourage interventional studies on correcting risk factors in this high-risk population.
KW - chronic kidney disease
KW - risk factors
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U2 - 10.1016/j.ekir.2018.01.002
DO - 10.1016/j.ekir.2018.01.002
M3 - Article
C2 - 29854970
AN - SCOPUS:85044849650
VL - 3
SP - 625
EP - 637
JO - Kidney International Reports
JF - Kidney International Reports
SN - 2468-0249
IS - 3
ER -